1 Author Affiliation: Department of Physical Medicine and Rehabilitation, Baylor Scott & White Research Institute, Dallas, Texas (Drs Quilico and Driver); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (Drs Quilico and Driver); Department of Applied Human Sciences, Concordia University, Montréal, Québec (Dr Quilico).

Objective: To update the status of physical activity research after moderate-to-severe traumatic brain injury (msTBI) by systematically reviewing empirical studies across health-related fields with the behavioral epidemiological framework to identify evidence-based interventions and inform future recommendations. The last review of physical activity research after msTBI, including studies between 2000 and 2012, found the field was in early stages of maturation.

Methods: Articles published between January 2012 and December 2024 were retrieved from PubMed, Embase, Ovid Medline, Scopus, Web of Science, Rehabilitation & Sports Medicine Source, and Google Scholar using keywords related to traumatic brain injury, physical activity, and health promotion. Two authors independently screened titles, abstracts, and full texts for peer-reviewed research about physical activity behavior for adults with msTBI. Data were abstracted from included studies by study authors and then categorized into to the framework's 5 unique stages of development.

Results: A total of 958 references were imported, 129 duplicates were removed, 829 were screened with title and abstract, 165 articles underwent full-text review, and 100 final articles met the inclusion criteria. Consensus was achieved across different stages of the review through critical discussion. 40% were categorized in Phase 1 (establishing connections between behavior and health); 6% in Phase 2 (developing methods for measuring behaviors); 44% in Phase 3 (examining factors that influence behavior); 10% in Phase 4 (evaluating behavior change interventions); and 0% in Phase 5 (dissemination of health promotion programs). Many excluded full-text studies (n = 39/60) did not separate results by condition/injury severity (i.e., stroke/mild TBI).

Conclusions: The greater number of studies in Phases 3 and 4 suggest the field has evolved in 12 years. The lack of progress in Phase 5 provides opportunity for implementation science efforts. Recommendations for physical activity behavior research after msTBI are discussed.